Where is spirituality on New Zealand’s national health agenda?

As part of the consultation on a new strategy for an ageing population, we've invited a range of experts and specialists to write on topics of their choice. In the following article Dr. Richard Egan and Hilda Johnson-Bogaerts consider spirituality and an ageing population.

Conspicuous by its absence say Dr. Richard Egan (of the Cancer Society Social & Behavioural Research Unit, Dunedin School of Medicine, University of Otago) and Hilda Johnson-Bogaerts, Director of The Selwyn Institute (of ageing and spirituality), Selwyn Foundation, Auckland.

Research, along with ‘real life’ experience, indicates the role of spirituality deserves more than just debate; particularly in the context of creating meaningful healthcare environments and establishing guidelines to help older people age well. A focus on spirituality is also closely aligned with the current development of the Government’s well-being framework. As a key dimension of well-being, spirituality needs to be included in this framework.

In The Surprising Health Benefits of Spirituality, published in the August 2016 edition of the internationally-regarded Psychology Today, Stanford University’s Dr. Emma Seppala makes the claim that people who have a spiritual element to their lives:

report being ‘very happy’;

have a longer life;

have a lower risk of depression and suicide;

are more resilient;

develop more faithful and enduring relationships;

have happier children and are more satisfied with family life.

Considering these tangible outcomes, tapping into a spiritual ‘wellspring’ as part of any serious national ageing agenda is a ‘no brainer’.

This is certainly our view, based on our work and experience. So, why are we not embracing the opportunity as fully as we could, or should? Part of the challenge is the many ways spirituality can be understood, along with differing perceptions about what spirituality is, fair or otherwise.

For millennia, and across the full spectrum of cultures and societies, spirituality has been linked with health, healing, well-being, tradition, history and overall life satisfaction. Meaning, and connection, as part of the human condition is nothing new. We need a ‘why’ to live for, at any age. For many this is the essence of spirituality.

However, until recently, in most countries and cultures the dominant practice and driving influence on the spiritual aspects of peoples’ lives has been organised religion. This convention has now been challenged, along with everything else in modern life. What people now regard as sources of spirituality have changed dramatically.

When we’re talking about spirituality, what exactly do we mean?

Dr. Christine Puchalski is an international leader in the movement to integrate spirituality into healthcare in clinical settings. Dr. Puchalski and her fellow contributors offered this definition in the May 2014 Journal of Palliative Medicine: Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.

In the context of a national focus on positive ageing, in 2010 Medscape (a leading source of online medical information for physicians and healthcare providers) published the following observation on why a re-focus on spirituality is taking place.

Interest in spirituality and aging has increased recently, owing to overwhelming evidence of positive health outcomes linked to spirituality and religious participation. Increasing longevity in modern society puts spiritual needs of older adults at the forefront of societal priorities.

Understanding individual spiritual perspectives becomes increasingly important, given the issues of loss, physical illness and mortality that are confronted in old age.

There are multiple barriers to the proper assessment of spirituality in clinical practice and research.

Integrating an individual's spiritual practice into their healthcare can help shape personalized medical care for older adults and improve health outcomes.

When understood broadly, spirituality is ultimately self-defined and experienced. However, Dr. Puchalski has identified some commonalities, as noted above. Her view is that spirituality is an inherent and fundamental component of being human. Spirituality is different from the psychological domain, which traditionally focuses on cognitive behavior, although there are obvious links.

A renewed focus on spirituality as a fundamental part of the ageing journey

In light of this ‘renaissance’, many countries have engaged in a more serious and formal approach to understanding, debating and formulating policy on spirituality’s influence and role.

In 2013 the Scottish-based charitable organisation Iriss—which promotes positive outcomes for people who use the country’s social services—considered spirituality across all aspects of community care and building, and concluded:

ageing is a journey which includes a spiritual dimension;

the spiritual dimension focuses on the meaning of life, hope and purpose, explored through relationships with others, with the natural world and with the transcendent;

the evidence base suggests that genuine and intentional accompaniment of people on their ageing journey — giving time, presence and listening — are the core of good spiritual practice;

reminiscence, life story, creative activities and meaningful rituals all help with the process of coming to terms with ageing and change.

Closer to home, Meaningful Ageing Australia is a national body for spiritual care and ageing, set up to enable access to high quality pastoral and spiritual care for all older people in the country.

This organisation notes:

Spirituality is integral to, but not confined by, religion and faith. It is about what gives us a purpose to our lives. It is about our sources of meaning and hope, which in turn are intimately related to our connectedness to ourselves, to others and to the world.

There is now a large body of emerging evidence showing that pastoral and spiritual care is an essential part of holistic care.

The Australian experience (and New Zealand research) shows that many people working in aged care understand the value of pastoral and spiritual care and want to have conversations around spirituality, but tend to stay at a superficial level because they don’t feel they have the knowledge or skills to respond at a deeper level. To lead and improve spiritual care, Meaningful Ageing Australia has developed National Guidelines for Spiritual Care in Aged Care.

Our own view on spirituality

While New Zealand has the opportunity to learn from these initiatives, in some areas we are already advanced in acknowledging spirituality as part of integrated health and well-being regimens. Māori, Pacific and many religious non-governmental organisations (NGOs) implicitly, and sometimes explicitly, acknowledge and include spirituality in their work. Mason Durie’s ubiquitous model of health, Te Whare Tapa Wha, includes spirituality/wairua. This model is taught in all State schools and in professional healthcare undergraduate courses.

At a policy level, cancer care leads the way, stating that “all staff working in cancer treatment services have a basic understanding of the spiritual needs of people with cancer”. Yet much of this is aspirational rather than everyday practice.

Also in the area of cancer care, He Anga Whakaahuru—A supportive care framework includes guidelines, competencies and standards for spiritual well-being as part of an integrated model.

Outside of these examples, references to spirituality are largely lacking in New Zealand’s health policy, professional guidelines, pre and in-service health education, standards and competencies.

We would like to challenge those who are reviewing aged care, healthy ageing and the health system generally, to not only include spirituality in the policy frameworks, but to also consider the development of New Zealand-specific national guidelines on spirituality.

This step would then provide the frame of reference for further understanding, and for engaging with this important aspect of the country’s health and well-being. It may go some way in further meeting our commitments under the Treaty of Waitangi, and will help us to work towards greater cultural competence across our multicultural ageing and health sectors.

The goal has been set. It is our responsibility to take up the challenge, starting with including spirituality in policy, understanding people’s spiritual needs and, of course, putting this policy and knowledge into practice through meaningful and sustainable action.

Dr. Richard Egan is Senior Lecturer and Co-Director of the Cancer Society Social and Behavioural Research Unit, Dunedin School of Medicine, University of Otago.

Hilda Johnson-Bogaerts is the Director of The Selwyn Institute (of ageing and spirituality), Selwyn Foundation, Auckland.